Dupuytrens disease

1. Dupuytrens DiseaseDupuytrens Disease
Dr Steve CarterDr Steve Carter

2. IntroductionIntroduction
 Dupuytrens description 1831Dupuytrens description 1831
 Plater 1614 Scandinavian literature 1700Plater 1614 Scandinavian literature 1700
 Cline proposed fasciectomy in 1787Cline proposed fasciectomy in 1787
 Cooper performed first fasciectomy 1822Cooper performed first fasciectomy 1822

3. EpidemiologyEpidemiology
 Common in Northern Europe 16% rises to 60% inCommon in Northern Europe 16% rises to 60% in
relativesrelatives
 Associations, diabetes, TB, Aids,Seizure disorders minorAssociations, diabetes, TB, Aids,Seizure disorders minor
traumatrauma
 Essentially Fibroblasts converted to myofibroblastsEssentially Fibroblasts converted to myofibroblasts

4. Anatomy / PathophysiologyAnatomy / Pathophysiology
 Palmar fascia triangular shape base at mcpsPalmar fascia triangular shape base at mcps
 4 longitudinal bands attached to skin intrinsic muscles4 longitudinal bands attached to skin intrinsic muscles

5. Anatomy / PathophysiologyAnatomy / Pathophysiology
 Begins as a palmar noduleBegins as a palmar nodule
 Extends distally as a cord Type 3 collagenExtends distally as a cord Type 3 collagen
myofibroblastsmyofibroblasts

6. ClinicalClinical
 Nodule / contractureNodule / contracture
 Activities of daily livingActivities of daily living
 Knuckle padsKnuckle pads
 Ledderhose Peyronies diseaseLedderhose Peyronies disease
 Other assoc CTS Trigger fingerOther assoc CTS Trigger finger
 Differentiation from BoutonniereDifferentiation from Boutonniere

7. Non operative treatmentNon operative treatment
 Steroids Anti-inflamatoriesSteroids Anti-inflamatories
 Clostridium collegenaseClostridium collegenase
 Mainstay of treatment remains surgicalMainstay of treatment remains surgical

8. Surgical IndicationsSurgical Indications
 Activities of daily living, Table top testActivities of daily living, Table top test
 MCP > 30 degree contractueMCP > 30 degree contractue
 PIP > 20 Degree contracturePIP > 20 Degree contracture

9. Surgical IndicationsSurgical Indications

10. Surgical treatmentSurgical treatment
 FasciotomyFasciotomy
 Regional FasciectomyRegional Fasciectomy
 Total FasciectomyTotal Fasciectomy
 DermatofasciectomyDermatofasciectomy
 Segmental AponeurectomySegmental Aponeurectomy
 McCash open palm techniqueMcCash open palm technique

11. Surgical treatmentSurgical treatment
 Skin IncisionsSkin Incisions

12. Surgical treatmentSurgical treatment
 DissectionDissection

13. Surgical treatmentSurgical treatment
 Joint releaseJoint release

14. Surgical treatmentSurgical treatment
 HeamostasisHeamostasis

15. Surgical treatmentSurgical treatment
 Skin ClosureSkin Closure

16. Surgical treatmentSurgical treatment
 PostoperativePostoperative

17. Surgical treatmentSurgical treatment
ComplicationsComplications
 HeamatomaHeamatoma
 Skin necrosesSkin necroses
 InfectionInfection
 Digital nerve and arteryDigital nerve and artery
 RSDRSD
 StiffnessStiffness
 Loss of strengthLoss of strength
 RecurrenceRecurrence

18. ConclusionConclusion